oa Fundamina : A Journal of Legal History - Equity and the development of the South African health care system : from the Public Health Act of 1919 to the present day

Volume 2003 Number 9
  • ISSN : 1021-545X
  • E-ISSN: 2411-7870



The aim of this paper is to explore the extent to which equity as a notion of fairness in access to health care has been integrated into the modern South African health care system. The paper discusses the main legislative and policy instruments that have shaped the South African health care system in modern history. It begins with an analysis of the main pillars of the Public Health Act of 19191 and stops at the National Health Bill of 2001. The point of departure is the ideal of creating a health care system that strives for egalitarianism in respect of access to health care services. It will be submitted that the Public Health Act of 1919 bequeathed to the country a system that was fragmented, dysfunctional, and above all, lacking in egalitarian values. Attempts to radically reform the Public Health Act through instruments such as the National Health Act of 1977 failed to change a system that was biased towards urban, curative and hospital-based care. Moreover, the intensification of racial segregation during the era of apartheid and the privatisation of health care services served to accentuate inequality in access to health care. It was not until the democratisation of South Africa that the health care system began in earnest to transform towards universal access to health care. At a policy level, the White Paper on Transformation of the Health System in South Africa (1997) stands as a beacon of change, with its emphasis on primary health care for all. At a legislative level, the Constitution acknowledges access to health care as a fundamental right. The current National Health Bill seeks to put on statutory footing the institutional framework for universal access to health care.

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